Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

HealthPayerIntelligence News

PA Attorney General Intervenes in UPMC, Highmark Health Dispute

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Pennsylvania Attorney General Josh Shapiro has filed a petition in Commonwealth Court to modify the consent decrees that govern the relationship between UPMC and Highmark Health, two of western Pennsylvania’s largest provider and...

Blue Cross, HCSC to Reduce Food Insecurity Among Plan Members

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Blue Cross Blue Shield (BCBS) Institute and Health Care Services Corporation (HCSC) have launched a health food delivery service that will help reduce food insecurity and health disparities for plan members. Called foodQ, the service will...

Medicaid Can Increase Hospital Revenue Recovery by $500,000

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Hospitals could increase their revenue recovery from Medicare bad debt by as much as ten percent per year by identifying insured patients who are also eligible for Medicaid, according to a recent TransUnion Healthcare analysis....

NCQA Seeks Comment on Proposed Updates to HEDIS Quality Measures

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The National Committee for Quality Assurance (NCQA) is seeking comments from health plans, purchasers, consumers, and other stakeholders on proposed updates to the Healthcare Effectiveness Data and Information Set (HEDIS)...

Senators Request Payer, Provider Data on Surprise Medical Billing

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Senators from both sides of the aisle have requested information from providers and payers regarding surprise medical billing. In a recently released letter, Senators Bill Cassidy (R-LA), Michael Bennet (D-CO), Todd Young (R-IN), Tom...

Medicare, Medicaid Best Private Plans for Containing Health Costs

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Medicare and Medicaid contain per enrollee health spending growth better than private insurance which likely indicates that recent policies will be key to sustaining this control, revealed a report conducted by the Urban Institute and...

Humana, Aledade Bring Value-Based Care to Medicare Advantage Members

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Humana and Aledade have announced a value-based care agreement that will increase access to value-based care for Medicare Advantage members. The partnership will enable physicians in Aledade’s accountable care organizations (ACOs)...

Atrius Health, Blue Cross to Create Alternative Payment Model

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Atrius Health and Blue Cross Blue Shield of Massachusetts have partnered to launch an advanced alternative payment model that will deliver a higher quality, more affordable healthcare experience. In this new venture, the organizations...

Cigna Value-Based Care Participation Tops 50%, Saving $600M

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Cigna has surpassed its goal of having 50 percent of its Medicare and commercial health reimbursements tied to value-based care models in top markets by the end of 2018, the payer announced. Between 2013 and 2017, value-based care...

Lyft Expands Work with BCBS, Humana Medicare Advantage Plans

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Rideshare company Lyft is expanding its collaboration with the Blue Cross Blue Shield (BCBS) Institute to offer non-emergency medical transportation (NEMT) to Medicare Advantage members. In a blog post on the company website, Lyft also...

91% of Physicians Say Prior Authorizations Negatively Impact Care

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Prior authorizations (PAs) are causing significant delays in care and adding unsustainably to the administrative burdens of physicians, according to a new survey published by the American Medical Association (AMA). The majority of...

PCPs, Psychiatrists Much Less Likely to Accept Medicaid

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Primary care providers (PCPs) and psychiatrists are among the least likely professionals to accept Medicaid, leaving patients without some of the most fundamental resources for preventing or managing chronic diseases, according to recent...

Marketing for Short-Term Health Plans May Mislead Consumers

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Websites and brokers that sell short-term health plans as a replacement for ACA-compliant coverage often fail to give consumers the detailed plan information necessary to inform their purchase, according to a study conducted by the Urban...

Single Payer, Public Options Become Focus of Healthcare Debate

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As the nation starts to turn its politics-weary eyes towards the 2020 election cycle, a new series of healthcare talking points are emerging, particularly from the left-hand side of the ideological spectrum. Terms like “single...

2019 Best in KLAS Taps Payer Price Transparency, Claims Solutions

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Change Healthcare, Health Solutions Plus (HSP), and Casenet were among the top-ranked solutions in the 2019 Best in KLAS report for price transparency, payer claims and administration, and payer quality analytics. MedInsight and Activate...

HHS Proposes Eliminating Drug Rebates to Cut Prescription Costs

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HHS has announced a proposal that would essentially eliminate the existing drug rebate process and instead encourage direct discounts to patients in an effort to control the costs of prescription drugs. The proposal would exclude drug...

Payers to Focus on Price Transparency, Data Exchange at HIMSS19

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Price transparency, data exchange strategies, and the challenges of addressing administrative burdens will be among the key discussion topics for payers at this year’s HIMSS Global Conference and Exhibition in Orlando, Florida. Over...

CMS to Expand Tailored Benefits for Medicare Advantage Plans

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CMS is proposing significant changes to Medicare Advantage geared towards expanding choice and increasing competitiveness in a highly lucrative market. The proposals would increase the number and scope of supplemental benefits available...

Medicare “What’s Covered” App Aims for Price Transparency

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CMS has launched a new price transparency app that shows users which medical services and tests are covered under Medicare, the agency announced in a recent blog post.   The free “What’s Covered” app provides users...

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